I didn’t anticipate that my latest required clinical training, which we undergo every few months to stay current, would focus on the Fourth and Fifth amendments of the U.S. Constitution.
I didn’t realize it because I’m a doctor, not a lawyer.
But there it was, sandwiched between the review on bloodborne pathogens and quizzes about HIPAA — information on unreasonable search and seizure and the right to remain silent. It was then that I realized that I was being prepared to be a doctor in an emerging police state.
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When I came back to clinical medicine this spring after taking a years-long break in the aftermath of working as a Covid doctor, I figured the anti-vax fever pitch would be the nexus of my struggle and heartache in the clinic. Instead, it has been the anxiety and depression questionnaires that have really caught me off guard.
In patient after patient, the scores on these screenings are sky-high, placing the majority squarely at risk for severe anxiety and depression. I see the same answers over and over, as if our patients are cribbing off each others’ answer sheets.
Over the last few weeks, how often have you been bothered by any of the following problems:
Feeling afraid as if something awful might happen?
Feeling down, depressed, or hopeless?
When I ask my patients directly about the results on the clipboard, I invariably hear the “Trump” spat out like an epithet in the exam room more than a few times per day.
There was the woman whose husband has his regular immigration check scheduled in two months, who wonders whether he will be disappeared. Insomnia. Panic Disorder.
There was the landscaper whose crew won’t show due to fear of kidnapping by ICE, who is now doing back-breaking work around the clock by himself. Anxiety. Arthritis flare.
I saw a daughter with legal status who is too anxious to leave the country to visit her elderly parents. Acute stress reaction. Depression.
I have been upping meds for anxiety, initiating prescriptions for depression, sending referrals to behavioral health and psychiatry marked “urgent” in numbers that are unprecedented. I listen, I grab a tissue, I console, I prescribe, I refer. Then I do it all over again for the next patient.
What does an act of resistance look like today?
Is it when we let our patients know their rights so they are less fearful that ICE will kidnap them away from their children? Is it when I reassure a trans patient that gender affirming care is primary care, and of course, we can and will take care of them? Is it when I tell my patient, the one with a newborn at home, whose birth control just failed, that termination of her pregnancy is an option and that the decision is hers and hers alone? Or is it simply looking a patient in the eyes and explaining why vaccines are effective, though they hear a different narrative from the voices on their screens? None of these interactions were once noteworthy. But now is a dangerous time.
There are no sacred spaces in this regime of terror. There is no safety, no guarantee, no reassurance that at any moment, some edict might come down from above, taking away our right to care for our patients in the way we deem medically necessary. The “don’t tread on me” folks have intensified their onslaught and invasion of our medical spaces. Gender affirming care could be struck down or put out of reach. Vaccines could become more difficult to obtain or be covered by insurance, even for those who want them, due to the presence of anti-vaxxers, such as Health and Human Services Secretary Robert F. Kennedy Jr., who have been installed in positions of power in place of credible scientists. And we already know that pregnant patients have started to die because the government thinks it knows better than doctors and their patients. What before was an invasion of our profession has now become literal invasions of our clinics and our hospitals, and ICE has seemingly been given the green light to do anything to anyone at any moment with impunity.
As I worked my way through the training modules about patients, privacy and probable cause, I armed myself with knowledge I hope I will never have to deploy. I now know who to call if law enforcement invades our clinic, and how I am allowed to exclude them from private areas. I learned I can ask if they have a warrant, and that I don’t have to divulge information or even say anything at all. I now know that I should quickly hit Windows Key+L on the keyboard to lock my screen immediately as my first act, in an attempt to protect my patients from being kidnapped by roving gangs of masked thugs who often refuse to identify themselves.
I can do these things, but it is sickening that I might actually have to. As doctors, we fight to get our patients’ needs met each day — we fight for the meds they need in a profit-based system, we fight to get them the imaging they need, the consults they need, the medical equipment they need — every single moment is a fight to keep our patients healthy. We shouldn’t also be forced to fight for their safety, their very lives, within the four walls of our clinics. Any delusion of American exceptionalism, any land-of-the-free facade that one may have clung to, has been upended in this new era as the reality of this country has been laid bare.
Even as I write this, I know much of it may sound like hyperbole, but we already have numerous real-world examples of the terror this administration has unleashed in my home state of California. ICE agents recently tried to break down a door to a surgery center. Enforcement agents lie to elementary school administrators in hopes of gaining access to young children. Militarized agents raided farms, injuring and terrorizing workers, which led to the death of a farmworker. These are realities that we should never normalize. They demand that we fight back with everything we’ve got.
As I finished my training, I thought about how many other clinics, schools, farms, and offices are arming their staff with the knowledge of how to defend themselves and others against their own government in this new period, now that we live in a burgeoning police state.
More than ever, it is up to us to protect each other.
As the annual budget for ICE goes from $8.7 billion to $27.7 billion, I wonder how many of us will have the courage of the staff members at The Ontario Advanced Surgery Center in Ontario, California, as they recently shielded a worker from the armed, masked men and shouted:
You don’t even have a warrant.
Dipti S. Barot is a primary care doctor, writer, educator in the San Francisco Bay Area. You can follow her on Bluesky @diptisbarot.bsky.social.
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